Relationship Between Mechanical Axis-Derived and Anatomic Landmark-Derived Femoral Rotation in TKA: A Three-Dimensional CT Study

We sought to determine the relationship between the mechanical axis-derived and the anatomic landmark-derived femoral rotational axes using three dimensional computed tomographic images of 20 lower extremities. The mechanical axis-derived femoral rotational axis was created on the distal articular surface of the femur using coronal mechanical limb axis and the reconstructed images of the femur. Then, we measured the angular difference between mechanical axis-derived and anatomic landmark-derived femoral rotational axes. The mechanical axis-derived femoral rotational axis was externally rotated with a mean of 2.2° (range, 0 to 4.7°; SD, 1.0) compared with the surgical epicondylar axis. Our findings should be considered to obtain a proper femoral rotational axis in total knee arthroplasty.     

Evaluation of the 3-Dimensional,Weight-Bearing Orientation of the Normal Adult Knee

The purpose of this study was to use 3-dimensional, weight-bearing images corrected for rotation to establish normative data of limb alignment and joint line orientation in asymptomatic, adult knees. One hundred adults (200 lower extremities) were recruited to receive weight-bearing, simultaneous biplanar imaging of both lower extremities. Multiple radiographic parameters were measured from 3D images, corrected for limb rotation. 70.0% of knees were in neutral, 19.5% in varus, and 10.5% in valgus overall alignment. Only 31 % of knees possessed both a neutral mechanical axis and the absence of joint line obliquity. There was substantial agreement between the 2D and 3D images for overall mechanical alignment (κ = 0.77), but only a moderate agreement for joint line obliquity (κ = 0.58). A substantial portion of asymptomatic adults possess either a varus or valgus mechanical alignment and joint line obliquity.     

Role of in vitamin D in irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common chronic functional gastrointestinal disorder affecting 10%-22% of adults. Its development is closely related to the gut microbiota, and the inflammatory and immune responses triggered by the gut microbiota can lead to IBS. Vitamin D (VD) effectively treats IBS with fewer side effects by improving gut microbiota, immune regulation, and anti-inflammatory effects. In the future, it is necessary to carry out epidemiological studies on the relationship between VD and IBS, clinical studies on the efficacy of supplementing VD to improve IBS, and animal studies on the mechanism of VD improving IBS. Therefore, this paper discussed the relationship between VD and IBS.     

Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey

ObjectiveTo identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days.Research MethodologyWe conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics.ResultsWe received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units.ConclusionWe found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.     

四川省绵阳市某农村地区癫痫患者婚姻现状调查

目的调查四川省绵阳市某农村地区癫痫患者婚姻现状及影响因素。方法依据卫生部疾病控制司癫痫防治项目指导组2005年3月制定的《中国农村地区癫痫防治管理》实施方案的要求,抽取四川省绵阳市游仙区和三台县参加农村地区癫痫防治管理项目的农村癫痫患者180例,采用农村地区癫痫患者婚姻状况调查表对其婚姻状况进行问卷调查。结果农村地区癫痫患者已婚率为48.5%,未婚和离异男性患者多于女性(71.1%vs.28.9%,59.4%vs.40.6%,P0.01)。影响癫痫患者结婚的因素为年龄(OR=2.426,95%CI:1.291~4.559)、性别(OR=3.483,95%CI:1.768~6.859)、经济收入(OR=1.981,95%CI:1.034~3.796)、起病年龄(OR=1.027,95%CI:1.008~1.047)。已婚患者的婚姻满意度高于离异患者[(3.28±0.73)vs.(2.62±0.82),P0.01],男性患者高于女性患者(P0.05),癫痫患者配偶的婚姻满意度低于癫痫患者[(3.28±0.73)vs.(2.62±0.82),P0.001]。结论该农村地区癫痫患者已婚率较低,男性患者更难结婚;年龄、性别、经济收入及起病年龄是癫痫患者结婚与否的主要影响因素;男性癫痫患者的婚姻状况值得更多关注。     

10例新发难治性癫持续状态患者的临床分析

目的总结并分析新发难治性癫持续状态(NORSE)的临床特点及预后。方法采用回顾性研究分析2011至2013年收治的10例NORSE患者的临床资料,并对其预后进行随访,平均随访时间1.5年。结果 9例患者发热后出现难治性癫持续状态(RSE)。急性期癫发作以部分发作为首发表现8例,继发全面性发作6例。急性期头颅MRI未见异常4例,颅内囊肿2例,余4例提示颅内信号异常。所有患者均接受正规抗癫药物治疗(3~9种),其中使用大剂量苯巴比妥4例、咪达唑仑7例、激素5例、静脉注射免疫球蛋白5例、生酮饮食治疗3例。随访期内仅1例应用3种抗癫药物14个月后无明确临床发作,7例仍有临床发作;1例处于植物状态,1例死亡。格拉斯哥预后评分5分1例,4分6例,3分1例,2分1例,1分1例。结论 NORSE是一组病因不明易发展为RSE的疾病,多种治疗常无效,预后多不良并遗留认知行为障碍。     

Surgical Treatment for Women with Breast Cancer in Relation to Socioeconomic and Insurance Status

Based on the National Breast Cancer Audit of the Royal Australasian College of Surgeons an association between patient age and type of breast cancer surgery received has already been demonstrated. The aim of this study is to assess the patterns of surgical treatment for women with early breast cancer in relation to socioeconomic and insurance status. Data on patient demographics, diagnostic, and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the National Breast Cancer Audit between 1998 and 2012 is used for this study. Tumor size, histologic grade, number of tumors, lymph node positivity, and lymphovascular invasion are the major prognostic factors adjusted for. Reconstruction following mastectomy is the most likely surgical procedure for the higher socioeconomic and privately insured patients. Mastectomy alone is the most likely surgical procedure for the lower socioeconomic and for public patients. No surgery is the most likely surgical outcome for the lower socioeconomic and the least likely for the higher socioeconomic population. Open biopsy is the most likely diagnostic procedure for the lower socioeconomic and fine needle aspiration for the higher socioeconomic population. Socioeconomic and insurance status, are both independently associated with the types of treatment and diagnostic procedure for women with breast cancer. Opportunities present to investigate an association of these factors with morbidity and survival outcomes.     

Decisional regret after robotic-assisted laparoscopic prostatectomy is higher in African American men

ObjectivesLongitudinal studies report racial disparities in prostate cancer (PCa) including greater incidence, more aggressive tumor biology, and increased cancer-specific mortality in African American (AA) men. Regret concerning primary treatment selection is underevaluated in patients with PCa. We investigated the relationships between clinicopathologic variables across racial and socioeconomic lines following robotic-assisted laparoscopic prostatectomy.Materials and methodsWe assessed treatment decisional regret using a validated questionnaire in a total of 484 white and 72 AA patients with PCa who were followed up for a median of 16.6 months post–robotic-assisted laparoscopic prostatectomy. Socioeconomic status (SES) information was aggregated from 2010 US census zip code data. Perioperative clinicopathologic characteristics and functional outcomes were compared between groups. Univariate and multivariate regression analyses were used to evaluate the influence of race, aggregate SES, and other clinical and demographic characteristics on decisional regret.ResultsThe majority (87.7%) of the population was not regretful of their decision to undergo treatment. However, a greater proportion of AA vs. white patients were regretful (20.6% vs. 11.2%, respectively; P = 0.03). AA and white men were similar on all functional, clinical, and pathologic features with the exception of younger age among AA men (56 vs. 60 y, respectively; P<0.001). Although there were significant differences in SES by race (P<0.001), regret did not differ by SES (β =?1.53; P = 0.15). Race, postoperative sexual dysfunction, pad usage, and length of hospital stay, however, were significantly associated with decisional regret.ConclusionsAA men were more regretful than white men, after adjusting for clinicopathologic characteristics and postoperative functional outcomes.